CA IC Announces Man Pleads Guilty To Committing $1.5 M WC Insurance Fraud

"Committing workers' comp insurance fraud drives up the cost of insurance for everyone," said Commissioner Poizner. "Thanks to the hard work of CDI investigators and local law enforcement, we were able to put an end to this costly scheme. If you are thinking about defrauding an insurance company, know that we will find you, and we will bring you to justice."

This case involved the following suspects: Montes (who operated as W.C. Surgery Centers and W.C.S.C. & Associates), Hector Porrata, Cara Cruz Thompson and George Martinez who engaged in the acts of grand theft and insurance fraud by fraudulently soliciting funds from AIG Claims Services and Matrix Absence Management Inc. for outstanding medical liens on workers compensation claims for services provided by medical providers.

Between August 2003 and January 2006, Montes fraudulently solicited funds from AIG Claims Services and Matrix Absence Management Inc. for outstanding medical liens on workers compensation claims for services rendered by medical providers. Montes issued letters to AIG Insurance Company and Matrix Absence Management Inc., indicating that his two companies had been authorized by the medical providers to negotiate, settle and collect monies to resolve unpaid liens. It is alleged that Montes did not have authority to resolve the unpaid liens.

Porrata, Cruz Thompson and Martinez were employed by AIG as workers' compensation insurance adjusters. As AIG employees, the three people allegedly made payments of nearly $1.2 million to W.C. Surgery Centers and W.C.S.C. & Associates.

On February 2, 2007, AIG received a demand on behalf of Coast Plaza Doctors Hospital for payment of almost $100,000 in outstanding medical liens. AIG discovered that they had paid W.C.S.C. & Associates for resolution of the lien. They also learned that they made 49 additional payments totaling almost $1.1 million to W.C.S.C, believing that the company was authorized to handle unresolved liens for various medical providers. AIG confirmed that all fifty payments to W.C.S.C. were caused to be paid by only three adjusters: Martinez, Cruz Thompson and Porrata.

California Department of Insurance and Orange County District Attorney's Office investigators discovered that the adjusters had worked together previously at another workers' compensation claims administrator, Matrix Absence Management, where they allegedly defrauded the company out of more than $310,000.

On May 7, 2010, three additional co-defendants were sentenced in connection with this case. Porrata, 46, of Moreno Valley plead guilty to 50 felony counts of grand theft, 50 felony counts of insurance fraud and one felony count of conspiracy. He was sentenced to eight years in state prison and ordered to pay $1,234,813.00 in restitution.

Cruz Thompson, 47, of Victorville plead guilty to 11 felony counts of grand theft, 11 felony counts of insurance fraud and one felony count of conspiracy. She was sentenced to two years in state prison and ordered to pay $224,653.33 in restitution.

Martinez, 43, of Apple Valley plead guilty to 11 felony counts of grand theft, 11 felony counts of insurance fraud and one felony count of conspiracy. He was sentenced to two years in state prison and ordered to pay $300,003.36 in restitution.

The Orange County District Attorney's Office is prosecuting this case.

Commissioner Poizner oversees sixteen CDI Enforcement Branch regional offices throughout the state. Nearly 2,800 insurance fraud-related arrests have been made by CDI since Commissioner Poizner took office in 2007 - more arrests than have been made during any other three year period, under any previous insurance commissioner.

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